Antonio José Ruiz-Rodríguez

The isolation of circulating tumour cells (CTCs) in colorectal cancer (CRC) mostly relies on the expression of epithelial markers such as EpCAM, and phenotypic characterisation is usually performed under fluorescence microscopy with only one or two additional markers. This limits the ability to detect different CTC subpopulations based on multiple markers. The aim of this work was to develop a novel protocol combining two platforms (IsoFlux^TM and ImageStream^®X) to improve CTC evaluation. Cancer cell lines and peripheral blood from healthy donors were used to evaluate the efficiency of each platform independently and in combination. Peripheral blood was extracted from 16 early CRC patients (before loco-regional surgery) to demonstrate the suitability of the protocol for CTC assessment. Additionally, peripheral blood was extracted from nine patients one month after surgery to validate the utility of our protocol for identifying CTC subpopulation changes over time. Results: Our protocol had a mean recovery efficiency of 69.5% and a limit of detection of at least four cells per millilitre. We developed an analysis method to reduce noise from magnetic beads used for CTC isolation. CTCs were isolated from CRC patients with a median of 37 CTCs (IQ 13.0–85.5) at baseline. CTCs from CRC patients were significantly (p < 0.0001) larger than cytokeratin (CK)-negative cells, and patients were stratified into two groups based on BRAF^V600E and PD-L1 expression on CK-positive cells. The changes observed over time included not only the number of CTCs but also their distribution into four different subpopulations defined according to BRAF^V600E and PD-L1 positivity. We developed a novel protocol for semi-automatic CTC isolation and phenotypic characterisation by combining two platforms. Assessment of CTCs from early CRC patients using our protocol allowed the identification of two clusters of patients with changing phenotypes over time.

Resumen La isquemia mesentérica aguda (IMA) es un cuadro clínico con una mortalidad que puede llegar al sesenta por ciento. Sus etiologías más frecuentes son la embólica y la trombótica. Mujer de 78 años pluripatológica que ingresa por dolor abdominal mesogástrico, diarrea e hiponatremia. Tras empeoramiento súbito se realiza angio-TC abdominal con hallazgos de isquemia mesentérica aguda por obstrucción de arteria mesentérica superior. El diagnóstico debe establecerse rápido y se basa en pruebas de imagen como el angio-TC. El tratamiento puede ser quirúrgico o mediante procedimientos endovasculares.

We present the case of a 50-year-old male diagnosed with myasthenia gravis, secondary to thymoma or Lambert-Eaton syndrome during the study of repeated vomiting. Gastrointestinal symptoms persisted despite the treatment of the thymoma. He suffered from sigma volvulus that required sigmoidectomy 9 years after diagnosis. Neuromuscular junction disorders are not characterized by gastrointestinal involvement, as in our case. They have previously sporadically been related to intestinal motility dysfunction.

After observing a case of a temporomandibular joint dislocation after an upper endoscopy, we carried out a literature review to find out how frequent it is and suggest the sedation as a possible risk factor to such complication.